=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699808675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT JOHN EARNEY D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 01/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 S CLAY ST
-----------------------------------------------------
City | MILLERSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44654-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-674-8080
-----------------------------------------------------
Fax | 330-674-4876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 547 128 W MCCONKEY STREET
-----------------------------------------------------
City | SHREVE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44676-0547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-567-3333
-----------------------------------------------------
Fax | 330-567-5919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 301-01-5084
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------